Comprehensive lecture notes/study guide that includes information on gas exchange unit, VQ matching, ET tubes, medications and nursing interventions, post intubation management, artificial airways, chest tubes, ventilators, respiratory conditions and diagnostic testing, pneumothorax, hemothorax, fl...
Gas Exchange Unit
● The purpose of the heart is to drive the hemoglobin to the cell
● The purpose of the lungs is to oxygenate and ventilate the hemoglobin
● To oxygen and ventilate hemoglobin, the brain, muscles of respiration, & the alveolar
capillary membrane must work well
● Brain controls the rate, character of respiration, & muscles of respiration
● Diaphragm promotes ventilation
● Alveolar capillary membrane is where gas exchange occurs
○ Oxygen molecules pass through the alveolar capillary membrane to the plasma as
a dissolved free molecule
○ Most of the oxygen molecules enter to the RBCs to bind to hemoglobin
○ CO2 diffuses from higher to lower concentration gradient
○ O2 diffuses from higher to lower concentration gradient
● Type 1 and type 2 cells in alveoli
○ Type 1- squamous cells that are responsible for gas exchange
■ The alveoli are single cell layer thick in line with squamous cells that
facilitate the diffusion of CO2 & O2 for gas exchange
○ Type 2- help produce surfactant
■ Prevent alveoli from collapsing
■ Atelectasis- alveoli collapse
V/Q Matching
● V- ventilation → gas in the alveolar sac
● Q- perfusion → blood in the capillary associated with the alveoli
● The goal is to have gas in the alveoli and blood in the capillary bed so that ventilation &
perfusion match
● A- Absolute shunt → pus/fluids in the lungs diverts oxygen
○ Pneumonia, pulmonary edema, ARDS
● C- matching
● E- Deadspace → no perfusion due to obstruction of the pulmonary capillary
○ Pulmonary embolism
● SpO2/SaO2- oxygen saturated in hemoglobin
● PaO2- partial oxygen dissolved in plasma not bound to hemoglobin
● Hypoxia- decreased oxygenation at the tissue level
, ● Hypoxemia- decreased oxygenation within arterial blood
O2-Hemoglobin Disassociation Curve
● Demonstrates the relationship of oxygen to hemoglobin
● Shows the affinity between Hgb and O2, how much is bound, and how much is freely
available
● Curve takes on sigmoidal shape
○ Hgb has an increased affinity for oxygen as the number of oxygen molecules
bound goes up
● Normal PaO2
○ 80-100
● Minimum oxygen concentration to provide enough oxygen to prevent ischemia is 90%
○ PaO2 also drops as fewer and fewer O2 are bound to Hgb
● PaO2 values are much slower than O2 saturation values
● Factors shifting the curve to the right (release/decreased affinity)
○ More O2 available so that tissues/cells can benefit from it
○ High hydrogen ions, low pH (respiratory acidosis)
○ High CO2
○ Increased temperature (fever)
○ Increased 2,3-BPG
■ Hyperthyroidism
■ Anemia
■ Chronic hypoxemia
● High altitude
● Congenital heart disease
○ Some congenital hemoglobinopathies
● Factors shifting the curve to the left (lock/increased affinity)
○ O2 and Hgb don’t want to let go, less O2 dropped off to the tissues
○ Low hydrogen ions, high pH (respiratory alkalosis)
○ Low CO2 (hyperventilation)
○ Low temperature (hypothermic)
■ Pulse ox may say 100%, but the patient is not getting the O2 at the tissues
because the Hgb and O2 are not letting go
○ Decreased 2,3-BPG
, ■ Byphospoglyceric acid
■ Chemical produced by RBCs that helps facilitate the release of O2 to the
tissues
■ Hypothyroidism
■ Bank blood → PRBCs don’t have 2,3-BPG
○ Some congenital hemoglobinopathies
○ Carboxyhemoglobin
■ Hemoglobin is more attracted to carbon monoxide than oxygen
Rapid Sequence Intubation (RSI)
● Rapid, concurrent administration of both sedative & paralytic agents to decrease the risk
of aspiration & injury to the patient (sedation first then paralytic)
● Not indicated for patients in cardiac arrest because they are already unresponsive
● Preparation
○ IV
■ Two large bore
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